My writings - and those of others.
Learning through Reflection
Watching a recent video on Farnham Street, I noted the emphasis on reflection after decision making. Shane Parrish observed that if we don’t review the choices we make after the fact, we don’t learn. Organizations that want to make a difference have the same weakness as individuals as the story in a recent Globe and Mail reveals. When someone like the Auditor General Brenda Lysyk releases a report, it reveals we fail to learn from past experience. Ideally all organizations would have such a function as an auditor general – non partisan, independent and speaking to the wider community. While taking a mini-sabbatical from some volunteer work, I found the report on how my province is doing in responding to the Covid-19 pandemic revealing – and thought provoking in the way organizations of all sizes operate.
In an emergency a command structure matters. I remember one I was involved in some years ago and the number was two persons. That made it clear and fortunately we didn’t have to add to it. Who leads? What is the meeting structure? Who takes minutes? How are decisions followed up?
Regrettably, this emergency response got off to a bad start. Ontario was one of the worst sites of the SARS epidemic earlier in the 21st century and recommendations from the Auditor General started in 2003. Among them was a Cabinet Committee for Emergency Management consisting of the Premier plus eight MPPs. That committee finally met for the first time in 2019 and three times in the early part of 2020 for updates and discussion. No minutes were taken. It never took the lead. Efforts instead were led by a group of 21 that expanded to 83 and ultimately to 500. Some did not know whether they were attending with specific responsibilities or were just there. Meetings started by teleconference with unidentified speakers or roles and only later moved to video conference. While the Chief Medical Officer of Health was named Co-Chair, he never chaired. Minutes of decisions were not made. Discussion, as we know, does not necessarily involve making choices.
In most organizations changeover in leadership occurs, but often a new team has no mandate or record from the past. Emergency plans were out-dated and staff was insufficient. To remedy that, the government hired consultants. I know that is a pattern for trying to fix things and I’ve even been one of them. In this case it was a top of the line firm (*single sourced with no competitive bids) resulting in a billing of $1.6 million to create a plan with its first meeting in April – and another $3.2 million to plan for the opening of schools. Neither plan has ever been released There has been little coordination with municipalities.
Lessons from the past were simply not learned. The SARS experience suggested taking early precautions even when the world was still learning about a new virus. Though travel was clearly a source of infections, people were encouraged to go on holidays during the March break. Expertise is often disregarded. The Chief Medical Officer of Health did not exercise his full powers in a medical emergency. Masks were not required until October 2020. Instructions to local authorities were delayed and had been requested as early as May. The Ministry of Health collected data rather than Public Health. Transparency of data was identified as a problem when the CMOH did not release information until Cabinet had approved it. There was a good deal of variety in how local authorities responded, causing further confusion.
The lessons learned were not carried out over time. The Auditor General’s department reviewed the recommendations of 2003 again in 2007, 2014 and 2017 and focused on the need for updating of contact tracing and laboratory procedures. The latter were still paper based and not integrated with public health information systems. Good procedures for testing, tracing and isolating could have reduced the spread by 80%. Targets – always a favorite of governments, were set – but never met, with the worst results in the largest populated areas. By the end of August 2020, Ontario had the third highest number of cases on the country and the second highest rate of deaths per 100,000. We could have done better.
But will we? Rather than reflect, all the government parties have immediately become defensive when they are faced with the reality of choices made in the past. What if, instead of defending themselves, the party in power could respond, “Yes, most of this is true, much as we don’t like to face it” rather than slamming the Auditor General. The opposition could respond, saying, “We agree and we wouldn’t necessarily have done better” rather than “We didn’t cause all these problems when we were in power in the past – it’s the current government’s fault”. What if they all stopped saying “It’s not US and THEM – it’s just US”? How are WE going to do this better from now on?
